Hypomethylating agents in relapsed and refractory AML: outcomes and their predictors in a large international patient cohort. Academic Article uri icon

Overview

abstract

  • Although hypomethylating agents (HMAs) are frequently used in the frontline treatment of older acute myeloid leukemia (AML) patients, little is known about their effectiveness in relapsed or primary treatment-refractory (RR)-AML. Using an international multicenter retrospective database, we studied the effectiveness of HMAs in RR-AML and evaluated for predictors of response and overall survival (OS). A total of 655 patients from 12 centers received azacitidine (57%) or decitabine (43%), including 290 refractory (44%) and 365 relapsed (56%) patients. Median age at diagnosis was 65 years. Best response to HMAs was complete remission (CR; 11%) or CR with incomplete count recovery (CRi; 5.3%). Additionally, 8.5% experienced hematologic improvement. Median OS was 6.7 months (95% confidence interval, 6.1-7.3). As expected, OS differed significantly by best response, with patients achieving CR and CRi having a median OS of 25.3 and 14.6 months, respectively. In multivariate analysis, the presence of ≤5% circulating blasts and a 10-day schedule of decitabine were associated with improved response rates, whereas the presence of >5% circulating blasts and >20% bone marrow blasts were associated with decreased OS. A significant subset of RR-AML patients (16%) achieved CR/CRi with HMAs and experienced a median OS of 21 months. Outside of a clinical trial, HMAs represent a reasonable therapeutic option for some patients with RR-AML.

publication date

  • April 24, 2018

Research

keywords

  • DNA Methylation
  • Decitabine
  • Leukemia, Myeloid, Acute
  • Salvage Therapy

Identity

PubMed Central ID

  • PMC5916007

Scopus Document Identifier

  • 85051645108

Digital Object Identifier (DOI)

  • 10.1182/bloodadvances.2018016121

PubMed ID

  • 29685952

Additional Document Info

volume

  • 2

issue

  • 8